Provider Demographics
NPI:1043644628
Name:MACAULAY, KRISTIN ANDRA (LPCC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANDRA
Last Name:MACAULAY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2058
Mailing Address - Country:US
Mailing Address - Phone:330-343-6631
Mailing Address - Fax:330-343-8818
Practice Address - Street 1:567 WABASH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-4143
Practice Address - Country:US
Practice Address - Phone:330-343-3050
Practice Address - Fax:330-343-3150
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100002101YM0800X
OHE.1800909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health